A convicted rapist who was scheduled for a heart transplant has given rise to a controversy about how much state-funded medical care prisoners are entitled to in a society where not every law-abiding citizen can afford to go the doctor.

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According to ABC, Kenneth Pike had already triple bypass, and was slated for a heart transplant costing $800,000. But he was also in the middle of an 18-40-year prison sentence for raping a 12-year-old, and the tab would be picked up by taxpayers in the state of New York. Public outcry followed — and Pike decided to turn down the operation as a result. But the question remains: should taxpayers foot the bill for procedures they themselves might not be able to pay for?

Carol Speach of Auburn, NY told ABC, "We do think that prisoners are treated much better than those on the outside. Everyone else is expected to pay for some of their health care." Of course, ordinary citizens can get health insurance through their employers, an option not open to prisoners — but the unemployed and those whose jobs don't offer coverage may indeed wonder why convicted felons have a better social safety net than they do. And Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania and author of books and articles on transplant ethics, told ABC that visitors to transplant centers often get a so-called "wallet biopsy" and are turned away if they can't pay, while Pike was subject to no such stricture.

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I talked to Caplan today, and he reiterated to me that transplant centers routinely deny procedures if patients can't afford them (the exception, he says, is kidney transplants, which are fully covered by Medicare). However, he says this doesn't mean prisoners should be denied care. He explained, "Doctors don't and shouldn't try to discriminate who's good, who's bad." He pointed out that lots of people on transplant lists have done things others would consider immoral, from irresponsible behavior to previous criminal convictions, and that it's not the job of medicine to decide who's worthy of care.

Caplan said that if taxpayers wanted to keep prisoners from getting transplants, they'd have to do it through legislation. He also said such legislation would be unlikely to pass, because denying prisoners necessary medical care would be ruled unconstitutional. And in any case, the solution to the inequality Speach recognizes isn't to keep prisoners from getting the healthcare they need — instead, Caplan says, "let's get health insurance for everybody else."